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      Dr. Hoenig et al highlight some of the intrinsic limitations of our retrospective cohort study. Although no control group was used, the annual incidence and prevalence of diabetes in our study group over the 1 year of follow-up was dramatically higher than expected in the general population. According to the Centers for Disease Control and Prevention, the average age-adjusted annual incidence rate of diabetes in adults from 2005 to 2007 was 11.1 per 1,000 individuals in Texas and 9.1 per 1,000 individuals for the entire United States population.

      Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System survey data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005–2007.

      The observed incidence rate for diabetes (301.6 per 1,000 subjects) in our cohort was markedly higher. Furthermore, the prevalence of diabetes in adults aged 65 to 74 years from 2005 to 2007 was 21.2% for Texas and 18.5% for the United States population.

      Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System survey data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005–2007.

      Although our patient population had a somewhat higher prevalence of diabetes at baseline (38%), at the end of 1 year of follow-up, the prevalence of diabetes (57%) was >2 times their Texan aged-matched counterparts and >3 times that of similar United States individuals, a magnitude suggesting a true finding.
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      References

      1. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System survey data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005–2007.

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      Linked Article

      • Motorized Scooters: Boon or Bane?
        American Journal of CardiologyVol. 106Issue 4
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          We read with interest the report by Zagol and Krasuski1 on motorized scooters. The investigators suggested that scooters can have detrimental long-term effects on cardiovascular risk and that their findings pertinent to risk should influence physician practice. We are concerned that the study's methods do not support such a conclusion. Specific limitations include the following: (1) the use of a retrospective cohort study design with no attempt to account for other factors potentially affecting outcomes (e.g., by using statistical, case-matched, or historical control), (2) incomplete data on other treatment pertinent to the outcomes being studied, and (3) very low survey response rates.
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